Hybrid RN Case Manager — Home‑Based Care Coordination

Commonwealth Care Alliance Inc; Malden (MA); Hybrid; USD 80,000 - 120,000; Full time

Job summary

Commonwealth Care Alliance in Massachusetts is seeking a Hybrid Registered Nurse (RN) Case Manager to provide monitoring, follow-up and clinical care management for dually eligible enrollees with complex needs. The role emphasizes coordinating care across providers and community resources to improve outcomes and quality of life.

The RN will lead an interdisciplinary team, perform assessments, develop and implement care plans, and ensure seamless transitions with travel to member homes as

Qualifications

• Associates of Science in nursing required.
• Registered Nurse able to serve people with complex needs.
• Care coordination or case management experience preferred.
• Medicaid/Medicare managed care experience preferred.

Responsibilities

• Engage enrollees in their homes to build a complex care management relationship.
• Liaise with healthcare providers, community resources and enrollees.
• Perform assessments including Comprehensive, MDS-HC, and risk assessments.
• Develop and implement care plans with routine updates.
• Lead ICT and collaborate to create holistic care plans.
• Oversee LTSS utilization and ensure services in place.
• Assist members in accessing housing, transportation, food, and social services.
• Educate members about Medicare/Medicaid benefits and services.
• Promote self-management and preventative care.
• Follow up after hospitalizations to prevent readmissions.
• Coordinate with PCPs and specialists to share information.
• Engage with community organizations and other providers to avoid duplication.
• Advocate for enrollee needs and preferences within the system.
• Monitor member satisfaction and address concerns.
• Travel regularly to member, provider and community sites.
• Report abuse or neglect as required by state law.
• Adhere to NCQA and Care Management standards.

Skills

Care coordination

Interdisciplinary teamwork

Communication skills

Microsoft Office

Education

AS degree in nursing

RN license

Case Management Certification preferred

Job description

Commonwealth Care Alliance in Massachusetts is seeking a Hybrid Registered Nurse (RN) Case Manager to provide monitoring, follow-up and clinical care management for dually eligible enrollees with complex needs. The role emphasizes coordinating care across providers and community resources to improve outcomes and quality of life.

The RN will lead an interdisciplinary team, perform assessments, develop and implement care plans, and ensure seamless transitions with travel to member homes as